To find out how the cardiology community was reacting in the first hours after the data release -- when many hadn't had the chance to actually peruse the information yet -- I reached out to professional societies and individual physicians.

A spokesperson for the Society for Cardiovascular Angiography and Interventions (SCAI) said the organization did not have a statement on the issue, and a counterpart at the American Heart Association declined to comment, deferring to the American College of Cardiology.

An ACC spokesperson told me, "At this time we are reviewing the data and we have reached out to members to inform them of the release, and we will keep our members updated on all the information they need to know so that they can address any questions they get on the issue."

A fuller response was given by ACC president-elect Kim Allan Williams Sr., MD, chief of cardiology at Rush University School of Medicine in Chicago.

He told one of my colleagues, "I don't actually have a problem with public reporting of my personal information. The problem is that there are some physicians who work really hard and bill a lot. They may be seen as dishonest when they are not. And my situation as an active mission, patients may look at the low amount of revenue generated by me and assume that I'm not a good clinician or I restrict my Medicare patient access.

"So it certainly may have its downsides. But there may be a few physicians who are overbilling since it was reported that a large percentage of the revenue was going to 2% of physicians. It would [also] not surprise me if a significant portion of those physicians were perfectly honest."

That difficulty in figuring out what the data actually mean was an issue also highlighted by Clyde Yancy, MD, chief of cardiology at Northwestern University's Feinberg School of Medicine and a past president of the AHA. Yancy said that "we should all embrace transparency but much like clinical data, context is needed."

He explained: "This surfeit of data addressing Medicare payments to physicians will force us all to decipher noise versus data versus fact versus fiction versus fraud. How can you know? It requires insight -- i.e., areas of specialization, patient mix, geographic mix, disease burden; and it requires patient-level data to understand how closely aligned these procedures are with indications.

"In the absence of both context and patient-level data, one is left to decipher. Even outliers (up to a point) may be exhibiting perfectly appropriate practice. There will be those with activity profiles that defy logic, but for the other 98%, the time spent addressing the optics and perspectives here will only serve to take away time better spent on providing best care."

"On the upside, we have experienced the impact of public reporting of re-hospitalization data and though awkward and at times even ugly, it has benefitted healthcare," Yancy said. "Will this kind of data release do the same thing? If so, it's worth the angst that will be generated and the scrutiny that some will experience; if not, then we've just created a lot more inertia than needed in the provision of healthcare."

Howard Weintraub, MD, clinical director of the NYU Center for the Prevention of Cardiovascular Disease, told me that he didn't think releasing the data was the right thing to do or that the data were correct, pointing out that they would not reflect the 6- to 8-week period in 2012 during which he wasn't able to practice because of an injury.

"I am not sure about accuracy and not convinced about the necessity," he said. "What good does this serve for patients or physicians? Who wins? How could this factor into choosing a doctor?"

J. James Rohack, MD, chief health policy officer for Baylor Scott & White Health and a senior staff cardiologist at Scott & White Memorial Hospital in Temple, Texas, had this to say about the need for context: "Releasing raw payment data that is not risk adjusted to the public without context of the individual patient needs is not good public policy. Transparency is important."

He said that a look at the raw data would imply that saving a patient's life with an acute angioplasty is worse than not doing a procedure and having a patient die because it costs more.

"The release of this raw data will result in the subsequent grouping by the media of physicians into the highest paid, with the suggestions that perhaps the care that is provided is wrong. Science has shown that those who do more procedures are more proficient with less complications," he said.

"In sports, one celebrates and rewards the best athletes by paying them the highest salaries. It is unclear the public benefit to give unclear guidance to patients and payers by raw data release allowing for invalid conclusions to be common. As a practitioner, I looked at my data and saw that the average payment from Medicare I received was $34.51. What a deal."

"I believe in transparency in everything, so I'm okay with that. But I can see the other camp," he said, referring to those who think the information should be confidential. "It reflects both on high and low income doctors because some patients might look at it and say, 'My doctor's not really that busy. I thought he was busier.' Or, 'My doctor might be committing fraud,' when they see balloon-size numbers. That's from the patient's perspective."

"From the doctor's perspective," he said, "if I'm practicing medicine in the usual ethical way, I should be happy regardless. My volume is my volume. Not all doctors take Medicare so this is somewhat of a skewed way of looking at business."

Aboufares said doctors with a low volume of Medicare business might respond to the data release by trying to bump up their numbers, whereas those at the higher end might try to scale back.

"But from a personal standpoint, I think transparency is very important, and maybe this is one way of catching fraud before it becomes a bigger fraud," he said.

CardioBuzz is a blog by Todd Neale for readers with an interest in cardiology.

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